What Is a Below the Knee Amputation?

The thigh amputations are usually selected at the mid thigh or at the junction of the middle and lower 1/3, because the plane muscles are plump, the blood circulation is rich, the wound is easy to heal, and it is suitable for the installation of prosthetics.

Basic Information

Chinese name: Thigh amputation
Anesthesia: Epidural anesthesia, spinal anesthesia, general anesthesia

Indication: Limbs cannot be rebuilt, malignant tumors
complication: Stump infection, hemorrhage, pain, atrophy

Thigh Amputation Anesthesia

Epidural block anesthesia or spinal and general anesthesia can be used.

Preparation for thigh amputation

1. Laboratory inspection.

2. Correct anemia, hypoproteinemia, improve coagulation function, and improve local blood supply.

3. Preparing skin, preparing blood, and applying antibiotics before surgery.

4. X-ray examination to determine the amputation plane.

Indications for thigh amputation

1. Peripheral vascular disease, such as ischemic necrosis of the limb caused by diabetes.

2. Trauma, such as severe trauma, the main blood vessels of the limb cannot be repaired and ischemic necrosis or reconstruction cannot be performed.

3. Nerve injury leads to nutritional ulcers and congenital malformations.

4. Malignant tumors of the knee joint and distant limbs, losing limb protection value.

Contraindications for thigh amputation

Shock

2. Liver and kidney dysfunction.

3. Coagulation dysfunction.

4. Severe anemia.

Thigh Amputation Procedure

1. Cut the skin with a scalpel and cut the muscles with an amputation knife.

2. Stop bleeding immediately.

3. Cut the soft tissue to the femur, peel the periosteum with a periosteal stripper, and pull the soft tissue to the proximal end with a hook.

4. Saw the femur with a swing saw.

5. Find out the sciatic nerve and peel it off as much as possible.

6. Then wrap the "quadriceps muscle skirt" around the bone end, and stitch its fascia layer with the fascia on the back of the thigh, trim the extra muscle or fascial tissue to make it more tidy.

7. Suture the subcutaneous and skin and leave the negative pressure drainage tube.

Thigh Amputation Complications

Pain in the stump and hemorrhage in the stump. Bleeding and hematoma stump protrusion, stump edema or atrophy, stump tightening, joint contracture, stump sinus and ulcer, stump infection.

Thigh amputation considerations

1. Postoperative psychological care: The patient's physical appearance changes after amputation, which causes a great blow to the patient's psychology, and the patient often produces depression and pessimism. Patients should be helped to self-regulate and face reality correctly.

2. The stump of the thigh is loosely bandaged with a tubular bandage or an elastic bandage.

3 The amputated limb should be examined histologically.

4 Do not use a tourniquet if you have blood flow problems.

5. When separating the neurovascular bundle, the operation should be gentle and careful to prevent injury. When the blood vessel is bleeding, immediately press the proximal end of the blood vessel to stop the bleeding.

6. If it is an osteosarcoma, the tissue in the medullary cavity should be subjected to a rapid biopsy of the frozen section; if it is a soft tissue tumor, the resection margin should also be subjected to a rapid biopsy.

7. The osteotomy margin should be smoothed with a bone file to prevent postoperative stump pain and affect the installation of the prosthesis.

Nursing after thigh amputation

1. Observe stump blood flow.

2. Reasonable application of antibiotics to prevent infection.

3. Application of analgesics.

4. For amputations above the mid thigh, the splint should be used to fix the hip joint in the extended position to prevent hip flexion and contracture deformity, and to exercise early hip hyperextension activities.

5. Evaluation of residual limbs: skin, shape, pain, muscle strength, circumference, joint range of motion.

6. Keep good limb position.

7. Wrap the bandage on the stump.

8. Physical recovery training.

9. Muscle recovery training.

10. Joint range of motion training.

11. Wheelchair operation training.

12. Training after the prosthesis.